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Jamaica

Health & safety

Before you go

Further reading

If you’re traveling with children, Lonely Planet’s Travel with Children may be useful. ABC of Healthy Travel by E Walker et al, and Medicine for the Outdoors by Paul S Auerbach, are other valuable resources.

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Insurance

If your health insurance does not cover you for medical expenses abroad, consider supplemental insurance. US travelers can find a list of medical-evacuation and travel-insurance companies on the US State Department website (www.travel.state.gov/medical.html). Find out in advance if your insurance plan will make payments directly to providers or reimburse you later for overseas health expenditure.

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Internet resources

There is a wealth of travel health advice on the internet. Lonely Planet (www.lonelyplanet.com) is a good place to start. The World Health Organization (www.who.int/ith/) publishes a superb book called International Travel and Health, which is revised annually and is available online on its website at no cost. Another website of general interest is MD Travel Health (www.mdtravelhealth.com), which provides c­omplete travel health recommendations for every country, updated daily, also at no cost.

It’s usually a good idea to consult your government’s travel health website before departure, if one is available.

Australia (www.smartraveller.gov.au)

Canada (www.hc-sc.gc.ca/english)

UK (www.doh.gov.uk/traveladvice)

USA (www.cdc.gov/travel)

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Medical checklist

Recommended items for a personal medical kit:

- acetaminophen/paracetamol (Tylenol) or aspirin

- adhesive or paper tape

- antibacterial ointment (eg Bactroban) for cuts and abrasions

- antibiotics

- antidiarrheal drugs (eg ­loperamide)

- antihistamines (for hay fever and allergic reactions)

- anti-inflammatory drugs (eg ­ibuprofen)

- bandages, gauze and gauze rolls

- DEET-containing insect repellent for the skin

- iodine tablets (for water ­purification)

- oral rehydration salts

- permethrin-containing insect spray for clothing, tents and bed nets

- pocketknife

- scissors, safety pins and ­tweezers

- steroid cream or cortisone (for poison ivy and other allergic rashes)

- sunblock

- syringes and sterile needles

- thermometer

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Bring medications in their original containers, clearly labeled. A signed, dated letter from your physician describing all medical conditions and medications, including generic names, is also a good idea. If you’re carrying syringes or needles, be sure to have a physician’s letter documenting their medical necessity.

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Recommended vaccinations

Since most vaccines don’t produce immunity until at least two weeks after they are given, visit a physician four to eight weeks before your departure. Ask your doctor for an international certificate of vaccination (known as the yellow booklet), which will list all the vaccinations you’ve received. It’s mandatory for countries requiring proof of yellow-fever vaccination upon entry, but it’s a good idea to carry it wherever you travel.

No vaccinations are required to enter Jamaica unless you have visited any of the following locations within the previous six weeks: Asia, Africa, Central and South America, Dominican Republic, Haiti or Trinidad and Tobago. Check with the Jamaica Tourist Board (JTB; www.visitjamaica.com) or your travel agent before departure to see what current regulations may be. Yellow fever is not a threat in Jamaica, but immunization may be required of travelers arriving from infected areas, chiefly in Africa and South America.

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Recommended vaccinations

Chickenpox For travelers who’ve never had chickenpox; two doses one month apart. Possible side effects are fever or a mild case of chickenpox.

Hepatitis A Recommended for all travelers; one dose before trip, and a booster six to 12 months later. Side effects may include soreness at injection site, headaches or body aches.

Hepatitis B Recommended for long-term travelers in close contact with the local population; three doses over six months. Side effects may include soreness at injection site or low-grade fever.

Measles One dose, recommended for travelers born after 1956 who’ve had only one measles vaccination. Side effects could include fever, rash, joint pains or allergic reactions.

Rabies For travelers who may have contact with animals and may not have access to medical care; three doses over three to four weeks. Possible side effects: soreness at injection site, headaches, body aches (and it’s expensive).

Tetanus-diphtheria For all travelers who haven’t had a booster within 10 years; one dose lasts 10 years. There may be some soreness at injection site.

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Dangers & annoyances

Crime

Jamaica has the highest murder rate for any country not in the throes of war (the nation had a record 1574 murders in 2007, a 17% rise on the previous year), and Kingston and Spanish Town have the worst reputations in the Caribbean for violent crime. Although the vast majority of violent crimes occur in ghettoes far from tourist centers, visitors are sometimes the victims of robbery and scams. Crime against tourists has dropped in recent years, however, and the overwhelming majority of visitors enjoy their vacations without incident.

Most crime against travelers is petty and opportunistic. Take sensible precautions with your valuables. Steer clear of ghettoes, where you are very likely to get into serious trouble. Try to avoid walking at night in Kingston and downtown Montego Bay, but if you do, stick close to main thoroughfares. Take taxis when possible, preferably arranged by the hotel’s front desk.

Keep hotel doors and windows securely locked at night, and lock car doors from the inside while driving. Don’t open your hotel door to anyone who can’t prove their identity. If you’re renting an out-of-the-way private villa or cottage, check in advance with the rental agency to establish whether security is provided. And don’t assume you’re entirely safe at all-inclusive resorts: readers have ­reported security issues even there.

Carry as little cash as you need when away from your hotel. Keep the rest in a hotel safe. You can rely on credit cards and traveler’s checks for most purchases, but you’ll need cash for most transactions in rural areas and at gas stations.

Many local police are members of the communities they serve and cannot always be trusted to be impartial.

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The Jamaica Tourist Board publishes a pocket-size pamphlet, Helpful Hints for Your Vacation, containing concise tips for safer travel. Use the JTB hotline (888-991-9999) for emergency assistance.

The US State Department (202-647-5225; www.travel.state.gov) publishes travel advisories that advise US citizens of trouble spots, as does the British Foreign & Commonwealth Office (020-7008-0232; www.fco.gov.uk; Travel Advice Unit, Consular Division, Foreign & Commonwealth Office, 1 Palace St, London SW1E 5HE).

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Gay & lesbian travelers

Jamaica is an adamantly homophobic nation. Sexual acts between men are prohibited by law and punishable by up to ten years in prison and hard labor. Some reggae dancehall lyrics by big-name stars like Beenie Man, Bounty Killer, Buju Banton and Sizzla seem intent on instigating violence against gays. Law enforcement in most cases fails to prosecute perpetrators of gay bashing: when gay-rights activist Brian Williamson was stabbed to death by a mob in June 2004, police maintained that he was a robbery victim. In 2007, Mandeville was the scene of several gay-bashing incidents, and a policeman who came out of the closet was forced to go into hiding.

The debate over institutional homophobia in Jamaica heated up in 2004 with the release of a report by Human Rights Watch detailing the abuse meted out to sexual minorities and people living with HIV/AIDS. As a form of protest, most gays refuse to visit the island; those who do find that they cannot express their sexuality openly without an adverse – and often dangerous – reaction.

J-Flag (helpline 978-8988; www.jflag.org) is Jamaica’s first human-rights organization created to serve the needs of sexual minorities.

The following organizations can provide assistance in planning a trip:

International Gay & Lesbian Travel Association (954-776-2626, 800-448-8550; www.iglta.com; 4431 N Federal Hwy No 304, Ft Lauderdale, FL 33308, USA)

Purple Roofs (www.purpleroofs.com/caribbean/jamaica.html) Lists gay-friendly accommodations in Jamaica.

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In transit

Deep vein thrombosis (DVT)

Blood clots may form in the legs during plane flights, chiefly because of prolonged immobility, and the longer the flight, the greater the risk. Though most blood clots are reabsorbed uneventfully, some may break off and travel through the blood vessels to the lungs, where they could cause life-threatening complications.

The chief symptom of deep vein thrombosis is swelling or pain in the foot, ankle or calf, usually but not always on just one side. When a blood clot travels to the lungs, it may cause chest pain and difficulty in breathing. Travelers with any of these symptoms should immediately seek medical attention.

To prevent development of deep vein thrombosis on long flights, you should walk about the cabin, perform isometric compressions of the leg muscles (ie contract the leg muscles while sitting), drink plenty of fluids and avoid alcohol and tobacco.

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Jet lag & motion sickness

Jet lag is common when crossing more than five time zones, and is characterized by insomnia, fatigue, malaise or nausea. To avoid jet lag, try drinking plenty of fluids (nonalcoholic) and eating light meals. Upon arrival, get exposure to natural sunlight and readjust your schedule (for meals, sleep etc) as soon as possible.

Antihistamines such as dimenhydrinate (Dramamine) and meclizine (Antivert, Bonine) are usually the first choice for ­treating motion sickness. Their main side effect is drowsiness. A herbal alternative is ginger, which works like a charm for some people.

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While you're there

Animal bites

Do not attempt to pet, handle or feed any animal, with the exception of domestic animals known to be free of any infectious disease. Most injuries caused by animals are directly related to a person’s attempt to touch or feed them.

Any bite or scratch by a mammal, including bats, should be promptly and thoroughly cleansed with large amounts of soap and water, then an antiseptic such as iodine or alcohol should be applied. The local health authorities should be contacted immediately regarding possible post- exposure rabies treatment, whether or not you’ve been immunized against rabies. It may also be advisable to start an antibiotic, since wounds caused by animal bites and scratches frequently become infected. One of the newer quinolones, such as levofloxacin (Levaquin), which many travelers carry in case of diarrhea, would be an appropriate choice.

Various fish and other sea creatures can sting or bite dangerously. Jamaica has no venomous snakes.

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Bedbugs, lice & scabies

Bedbugs often live in dirty mattresses and bedding. Spots of blood on bedclothes or on the wall around the bed can be read as a suggestion to find another hotel.

Lice, which are easier to see, cause itching and discomfort. They make themselves at home in your hair (head lice), clothing (body lice) or pubic hair (crabs). You catch lice through direct contact with infected people or by sharing combs, clothing and the like. Powder or shampoo treatment will kill the lice.

Likewise, scabies – an infestation of microscopic mites – is acquired through sexual contact, bed linen, towels or clothing. The first sign – severe itching caused by an infestation of eggs and feces under the skin – usually appears three to four weeks after exposure (as soon as 24 hours for a second exposure) and is worse at night. Infestation appears as tiny welts and pimples, often in a dotted line, most commonly around the groin and the lower abdomen, between the fingers, on the elbows and under the armpits. Treatment is by pesticidal lotions.

At the same time as using the treatment, you must wash all your clothing and bedding in hot water.

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Cuts & scratches

Skin punctures can easily become infected in hot climates and may be difficult to heal. Treat any cut with an antiseptic. Where possible, avoid bandages and Band-Aids, which can keep wounds wet. Coral cuts are notoriously slow to heal, as the coral injects a weak venom into the wound. Clean any cut thoroughly with sodium peroxide if available.

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Food

Salads and fruit should be washed with purified water or peeled where possible. Ice cream is usually OK, but beware of street vendors who sell ice cream that has melted and been refrozen. Thoroughly cooked food is safest, but not if it has been left to cool or has been reheated. Shellfish such as oysters and clams should be avoided as well as undercooked meat, particularly in the form of mince. Steaming does not make shellfish safe to eat. Wash your hands before eating.

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Mosquito bites

To prevent bites wear long sleeves, long pants, hats, and shoes rather than sandals. Bring a good insect repellent, preferably one containing DEET, which should be applied to exposed skin and clothing but not to the eyes, mouth, cuts, wounds or irritated skin. In general, adults and children over 12 should use preparations that contain 25% to 35% DEET, which usually lasts for about six hours. Children between two and 12 years of age should use preparations containing no more than 10% DEET, applied sparingly, which will usually last for about three hours. Products that contain lower concentrations of DEET are as effective, but for shorter periods of time. Neurological toxicity has been reported from DEET, especially in children, but appears to be extremely uncommon and generally related to overuse. Compounds containing DEET should not be used on children under the age of two.

Insect repellents containing certain botanical products, including eucalyptus oil and soybean oil, are effective but last only 1½ to two hours. Products based on citronella are not effective.

For additional protection, you can apply permethrin to clothing, shoes, tents and bed nets. Permethrin treatments are safe and remain effective for at least two weeks, even when items are laundered. Permethrin should not be applied directly to skin.

Don’t sleep with the window open unless there is a screen. If sleeping outdoors or in accommodations that allow entry of mosquitoes, use a bed net, preferably treated with permethrin, with edges tucked in under the mattress. The mesh size should be less than 1.5mm. If the sleeping area is not otherwise protected, use a mosquito coil, which will fill the room with insecticide through the night. Wristbands impregnated with repellent are not effective.

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No-see-’ums

These well-named irritants are almost microscopically small fleas that hang out on beaches and appear around dusk (especially after rain), and have a voracious appetite. Their bite is out of all proportion to their size. Most insect repellents don’t faze them. A better bet is a liberal application of Avon’s Skin So Soft, a cosmetic that even the US Army swears by.

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Sea creatures

Spiny sea urchins and coelenterates (coral and jellyfish) are a hazard in some areas. If you’re stung by a coelenterate, apply diluted vinegar or baking soda. Remove tentacles carefully, and not with bare hands. If you get stung by a stinging fish, such as a stingray, immerse the limb in water at about 45°C.

Local advice on where to swim is the best way to avoid contact with jellyfish. If you get stung, dousing with vinegar will deactivate any stingers that have not ‘fired.’ In addition to calamine lotion, antihistamines and analgesics may reduce the reaction and relieve the pain.

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Sun

To protect yourself from excessive sun exposure, you should stay out of the midday sun, wear sunglasses and a wide-brimmed sun hat, and apply sunscreen with a sun protection factor (SPF) of 15 or higher, with both UVA and UVB protection. Sunscreen should be generously applied to all exposed parts of the body approximately 30 minutes before sun exposure and should be reapplied after swimming or vigorous activity. Travelers should also drink plenty of fluids and avoid strenuous exercise when the temperature is high.

You’ll sweat profusely in Jamaica. Don’t rely on feeling thirsty to indicate when you should drink water. Not needing to urinate, or very dark yellow urine, is a sign of dehydration. You’ll lose quite a bit of salt through sweating. Salt deficiency is characterized by fatigue, lethargy, headaches, giddiness and muscle cramps, and in this case salt tablets may help. Vomiting or diarrhea can also deplete your liquid and salt levels. Anhydrotic heat exhaustion, caused by an inability to sweat, is quite rare. Unlike other forms of heat exhaustion, it is likely to strike people who have been in Jamaica’s hot climate for some time, rather than newcomers.

Long, continuous periods of exposure to high temperatures can leave you vulnerable to heat stroke, a sometimes fatal condition that occurs if the body’s heat-regulating mechanism breaks down and the body temperature rises to dangerous levels.

The symptoms are feeling unwell, not sweating very much (or at all) and a high body temperature. Where sweating has ceased, the skin becomes flushed and red. Severe throbbing headaches and lack of coordination will also occur, and the sufferer may be confused or aggressive. Eventually the victim will become delirious or convulse. Hospitalization is essential, but meanwhile get victims out of the sun, remove their clothing, cover them with a wet sheet or towel and fan them continually.

Prickly heat is an itchy rash caused by excessive perspiration trapped under the skin. It usually strikes people who have just arrived in a hot climate and whose pores have not yet opened sufficiently to cope with increased sweating. To alleviate symptoms, keep cool and bathe often, use a mild talcum powder, or resort to air-con.

Don’t underestimate the power of the tropical sun, no matter how dark your skin color. You can get sunburned surprisingly quickly, even on cloudy days. Use a sunscreen of SPF 15 or more. Build up your exposure to the sun gradually. A hat provides added protection, and you should also use a barrier cream for your nose and lips. If you do get burned, calamine lotion and aloe vera will provide soothing relief.

Avoid booze by day, as your body uses water to process alcohol. Drink water, or ­coconut water straight from the husk.

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Water

Water is generally safe to drink from faucets throughout the island except in the most far-flung rural regions. It is safest, however, to stick with bottled water. It’s a good idea to avoid ice, particularly ice sold at street stands as ‘bellywash, ’ ‘snocones’ or ‘skyjuice, ’ shaved-ice cones sweetened with fruit juice.

Unless you’re certain that the local water is not contaminated, you shouldn’t drink it. Vigorous boiling for one minute is the most effective means of water purification. At altitudes greater than 2000m, boil for three minutes. In Jamaica’s backwaters, clean your teeth with purified water rather than tap water.

Another option is to disinfect water with iodine pills. Instructions are usually enclosed and should be carefully followed. Or you can add 2% tincture of iodine to one quart or liter of water (five drops to clear water, 10 drops to cloudy water) and let it stand for 30 minutes. If the water is cold, longer times may be required. The taste of iodinated water may be improved by adding vitamin C (ascorbic acid). Iodinated water should not be consumed for more than a few weeks. Pregnant women, people with a history of thyroid disease and those allergic to iodine should not drink ­iodinated water.

A number of water filters are available on the market. Those with smaller pores (reverse osmosis filters) provide the broadest protection but they are relatively large and are readily plugged by debris. Those with somewhat larger pores (microstrainer filters) are ­ineffective against viruses, although they remove other organisms. Manufacturers’ instructions must be carefully followed.

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Worms

Parasitic worms are common in rural tropical areas. They can be present on unwashed vegetables or in undercooked meat, and you can pick them up through your skin by walking barefoot. If left untreated, they can cause severe health problems.

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Dengue fever

Although extremely rare, dengue fever is present in Jamaica, notably in Portland parish and around Kingston. Dengue is a viral infection transmitted by Aedes mosquitoes, which bite mostly during the daytime and are usually found close to human habitations, often indoors. They breed primarily in artificial water containers such as jars, barrels, cisterns, metal drums, plastic containers and discarded tires. As a result, dengue is especially common in densely populated, urban environments.

Dengue usually causes flulike symptoms that can include fever, muscular aches, joint pains, headaches, nausea and vomiting, often followed by a rash. The experience of body aches may be quite uncomfortable but most cases resolve uneventfully within a few days. Severe cases usually occur in children under 15 who are experiencing their second dengue infection.

There is no treatment for dengue fever except to take analgesics such as acetaminophen or paracetamol (Tylenol) and drink plenty of fluids. Severe cases may require hospitalization for intravenous fluids and supportive care. There is no vaccine.

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Hepatitis A

In Jamaica hepatitis A is the second most common travel-related infection (after traveler’s diarrhea). Hepatitis A is a viral infection of the liver that is usually acquired by ingestion of contaminated water, food or ice, though it may also be acquired by direct contact with infected persons. The illness occurs throughout the world, but the incidence is higher in developing nations. Symptoms may include fever, malaise, jaundice, nausea, vomiting and abdominal pain. Most cases resolve without complications, though it occasionally causes severe liver damage. There is no treatment.

The vaccine for hepatitis A is extremely safe and highly effective. If you get a booster six to 12 months later, it lasts for at least 10 years. You really should get it before you go to any developing nation. Because the safety of hepatitis A vaccine has not been established for pregnant women or children under age two, they should instead have a gammaglobulin injection.

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Hepatitis B

Like hepatitis A, hepatitis B is a liver infection that occurs worldwide but is more common in developing nations. Unlike hepatitis A, the disease is usually acquired by sexual contact or by exposure to infected blood, generally through blood transfusions or contaminated needles. The vaccine is recommended for long-term travelers (on the road for more than six months) who expect to live in rural areas or have close physical contact with locals. Additionally, the vaccine is recommended for anyone who anticipates sexual contact with the local inhabitants or possible medical, dental or other treatments while abroad, especially if a need for transfusions or injections is expected.

Hepatitis B vaccine is safe and highly effective. However, three injections are necessary to establish full immunity. Several countries added hepatitis B vaccine to the list of routine childhood immunizations in the 1980s, so many young adults are already protected.

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HIV/AIDS

In 2005 around 1.5% of all Jamaican adults carried HIV, and that percentage is believed to have risen. The Caribbean is the second-worst affected region in the world, after sub-Saharan Africa. Be sure to use condoms for all sexual encounters. If you think you might visit a piercing or tattoo parlor, or if you have a medical condition that might require an injection, make certain you bring along your own sterile needles.

Jamaica has a toll-free AIDS/STD Helpline (888-991-4444, 967-3830; 10am-10pm Mon-Fri).

Jamaica AIDS Support (JAS; Kingston 978-2345; 4 Upper Musgrave Ave; Montego Bay 952-9817; 1st fl, Van Haze Bldg, 16 East St; Ocho Rios 974-7236; www.jamaicaaidssupport.com; McDowell Bldg, Pineapple Pl) operates a hospice and provides assistance for anyone infected with HIV.

The website of the National AIDS Committee (967-1100; www.nacjamaica.com; 2-4 King St, 4th fl, Oceana Bldg, Kingston) is an informative resource.

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Sexually transmitted diseases

There’s a high prevalence of venereal disease in Jamaica. Gonorrhea and syphilis are the most common; sores, blisters or rashes around the genitals and discharges or pain when urinating are common symptoms. Symptoms for women may be less marked or not observed. Syphilis symptoms eventually disappear, but the disease continues and can cause severe problems, even death, in later years. The treatment of gonorrhea and syphilis is by antibiotics.

While sexual abstinence is the only certain preventative, using condoms is also effective. High-quality condoms are readily available in Jamaica’s resort areas, but less so in the smaller towns.

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Tetanus

This potentially fatal disease is present in Jamaica as in other tropical areas. It is difficult to treat, but is preventable with immunization. Tetanus (lockjaw) occurs when a wound becomes infected by a germ that lives in the feces of animals or people; clean all cuts, punctures or animal bites. The first symptom may be discomfort in swallowing, or stiffening of the jaw and neck, followed by painful convulsions of the jaw and whole body.

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Children & pregnant women

In general, it’s safe for children and pregnant women to go to Jamaica. However, because some of the vaccines are not approved for use in children and pregnant women, these travelers should be particularly careful not to drink tap water or consume any questionable food or beverage. When traveling with children, make sure that all their routine immunizations are up to date. It’s sometimes appropriate to give children some of their vaccines a little early before visiting a developing nation. You should discuss this with your pediatrician. If pregnant, you should bear in mind that, should a complication such as premature labor develop while you’re abroad, the quality of medical care available may not be comparable to that in your home country.

The yellow fever vaccine is not recommended for pregnant women or children less than nine months old. If arriving from a country with yellow fever, these travelers should obtain a waiver letter, preferably written on letterhead stationery and bearing the stamp used by official immunization centers to validate the international certificate of vaccination.

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Availability & cost of health care

Acceptable health care is available in most major cities and larger towns throughout Jamaica, but may be hard to locate in rural areas. Most travelers will find the quality of health care will not be comparable to that in their home country. To find a good local doctor, your best bet is to ask the management of the hotel where you are staying or contact your embassy in Kingston or Montego Bay.

Many doctors and hospitals expect payment in cash, regardless of whether you have travel health insurance. If you develop a life-threatening medical problem, you’ll probably want to be evacuated to a country with state-of-the-art medical care. Since this may cost tens of thousands of dollars, be sure you have insurance to cover this before you depart.

Many pharmacies are well supplied, but important medications may not be consistently available. Be sure to bring along adequate supplies of all prescription drugs.

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Traveler’s diarrhea

Throughout most of Jamaica, tap water has been treated and is safe to drink, but in some far-flung rural areas it is safest to avoid it unless it has been boiled, filtered or chemically disinfected (with iodine tablets). To prevent diarrhea, eat fresh fruits or vegetables only if cooked or peeled; be wary of dairy products that might contain unpasteurized milk; and be highly selective when eating food from street vendors.

If you develop diarrhea, be sure to drink plenty of fluid, preferably an oral rehydration solution containing lots of salt and sugar. A few loose stools don’t require treatment, but if you start having more than four or five stools a day, you should start taking an antibiotic (usually a quinolone drug) and an antidiarrheal agent (such as loperamide). If diarrhea is bloody or persists for more than 72 hours, or is accompanied by fever, shaking chills or severe abdominal pain, you should seek medical attention.

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